Wisconsin

Innovations

Funded by and receiving referrals from the various public systems serving at-risk youth, Wraparound Milwaukee pays for and supports the provision of coordinated mental health and support services to children and adolescents with serious emotional and mental health needs, leading to less institutionalization and recidivism, lower costs, increased school attendance, better functioning at home and in school, and high satisfaction.

Care coordinators in a large integrated system engage in culturally tailored discussions with low-income seniors about completing advance directives, leading to higher completion rates and a narrowing of the gap in completion rates between African Americans/black immigrants and whites.

An online clinic enhances access to and reduces the costs of care for 40 minor health problems that can safely be handled without a face-to-face visit, generating significant time savings and positive feedback from patients, physicians, and payers.

With support from a statewide collaborative, primary care practices in Wisconsin proactively identify and address behavioral health issues in patients, leading to declines in binge drinking, marijuana use, and symptoms of depression, and to high levels of patient satisfaction.

Emergency department–based case managers at nine Milwaukee hospitals use electronic technologies to schedule and track attendance at follow-up clinic appointments for low-income, uninsured patients who come to the emergency department with nonurgent needs, allowing many such patients to establish a medical home.

A redesigned inpatient care model based on Toyota Production System principles uses daily multidisciplinary clinical team visits, individualized care plans, and facility and staffing changes to reduce costs and average length of stay and improve adherence to recommended care processes, nurse productivity, and patient, staff, and physician satisfaction.

Hospital-based interdisciplinary teams conduct daily reviews of real-time information on all inpatients ages 65 and older to identify and address risk factors that can lead to negative outcomes; the program reduced use of urinary catheters and increased use of physical therapy and social work evaluations.

Trained health care providers educate patients who use tobacco about the state's free tobacco cessation phone counseling service (called a “quitline”) and then fax a referral form to quitline staff who proactively follow up with the patient; the program led to higher quit rates than among those simply informed about the quitline by their providers.